Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Female Reproductive System Reconstructive Procedures

Facility

IP

$7,769.41

Service Code	APR-DRG 5142
Hospital Charge Code	APRDRG5142
Min. Negotiated Rate	$7,769.41
Max. Negotiated Rate	$7,769.41
Rate for Payer: AHCCCS Medicaid	$7,769.41
Rate for Payer: Allwell Medicaid	$7,769.41
Rate for Payer: AZCH Complete Medicaid	$7,769.41
Rate for Payer: Banner UC Health Medicaid	$7,769.41
Rate for Payer: Mercy Care Medicaid	$7,769.41

Female Reproductive System Reconstructive Procedures

Facility

IP

$25,511.32

Service Code	APR-DRG 5144
Hospital Charge Code	APRDRG5142
Min. Negotiated Rate	$25,511.32
Max. Negotiated Rate	$25,511.32
Rate for Payer: AHCCCS Medicaid	$25,511.32
Rate for Payer: Allwell Medicaid	$25,511.32
Rate for Payer: AZCH Complete Medicaid	$25,511.32
Rate for Payer: Banner UC Health Medicaid	$25,511.32
Rate for Payer: Mercy Care Medicaid	$25,511.32

Female Reproductive System Reconstructive Procedures

Facility

IP

$5,050.08

Service Code	APR-DRG 5141
Hospital Charge Code	APRDRG5143
Min. Negotiated Rate	$5,050.08
Max. Negotiated Rate	$5,050.08
Rate for Payer: AHCCCS Medicaid	$5,050.08
Rate for Payer: Allwell Medicaid	$5,050.08
Rate for Payer: AZCH Complete Medicaid	$5,050.08
Rate for Payer: Banner UC Health Medicaid	$5,050.08
Rate for Payer: Mercy Care Medicaid	$5,050.08

Female Reproductive System Reconstructive Procedures

Facility

IP

$25,511.32

Service Code	APR-DRG 5144
Hospital Charge Code	APRDRG5143
Min. Negotiated Rate	$25,511.32
Max. Negotiated Rate	$25,511.32
Rate for Payer: AHCCCS Medicaid	$25,511.32
Rate for Payer: Allwell Medicaid	$25,511.32
Rate for Payer: AZCH Complete Medicaid	$25,511.32
Rate for Payer: Banner UC Health Medicaid	$25,511.32
Rate for Payer: Mercy Care Medicaid	$25,511.32

Female Reproductive System Reconstructive Procedures

Facility

IP

$5,050.08

Service Code	APR-DRG 5141
Hospital Charge Code	APRDRG5144
Min. Negotiated Rate	$5,050.08
Max. Negotiated Rate	$5,050.08
Rate for Payer: AHCCCS Medicaid	$5,050.08
Rate for Payer: Allwell Medicaid	$5,050.08
Rate for Payer: AZCH Complete Medicaid	$5,050.08
Rate for Payer: Banner UC Health Medicaid	$5,050.08
Rate for Payer: Mercy Care Medicaid	$5,050.08

Female Reproductive System Reconstructive Procedures

Facility

IP

$5,050.08

Service Code	APR-DRG 5141
Hospital Charge Code	APRDRG5142
Min. Negotiated Rate	$5,050.08
Max. Negotiated Rate	$5,050.08
Rate for Payer: AHCCCS Medicaid	$5,050.08
Rate for Payer: Allwell Medicaid	$5,050.08
Rate for Payer: AZCH Complete Medicaid	$5,050.08
Rate for Payer: Banner UC Health Medicaid	$5,050.08
Rate for Payer: Mercy Care Medicaid	$5,050.08

Female Reproductive System Reconstructive Procedures

Facility

IP

$7,769.41

Service Code	APR-DRG 5142
Hospital Charge Code	APRDRG5141
Min. Negotiated Rate	$7,769.41
Max. Negotiated Rate	$7,769.41
Rate for Payer: AHCCCS Medicaid	$7,769.41
Rate for Payer: Allwell Medicaid	$7,769.41
Rate for Payer: AZCH Complete Medicaid	$7,769.41
Rate for Payer: Banner UC Health Medicaid	$7,769.41
Rate for Payer: Mercy Care Medicaid	$7,769.41

Female Reproductive System Reconstructive Procedures

Facility

IP

$7,769.41

Service Code	APR-DRG 5142
Hospital Charge Code	APRDRG5144
Min. Negotiated Rate	$7,769.41
Max. Negotiated Rate	$7,769.41
Rate for Payer: AHCCCS Medicaid	$7,769.41
Rate for Payer: Allwell Medicaid	$7,769.41
Rate for Payer: AZCH Complete Medicaid	$7,769.41
Rate for Payer: Banner UC Health Medicaid	$7,769.41
Rate for Payer: Mercy Care Medicaid	$7,769.41

Female Reproductive System Reconstructive Procedures

Facility

IP

$14,027.30

Service Code	APR-DRG 5143
Hospital Charge Code	APRDRG5143
Min. Negotiated Rate	$14,027.30
Max. Negotiated Rate	$14,027.30
Rate for Payer: AHCCCS Medicaid	$14,027.30
Rate for Payer: Allwell Medicaid	$14,027.30
Rate for Payer: AZCH Complete Medicaid	$14,027.30
Rate for Payer: Banner UC Health Medicaid	$14,027.30
Rate for Payer: Mercy Care Medicaid	$14,027.30

Female Reproductive System Reconstructive Procedures

Facility

IP

$14,027.30

Service Code	APR-DRG 5143
Hospital Charge Code	APRDRG5144
Min. Negotiated Rate	$14,027.30
Max. Negotiated Rate	$14,027.30
Rate for Payer: AHCCCS Medicaid	$14,027.30
Rate for Payer: Allwell Medicaid	$14,027.30
Rate for Payer: AZCH Complete Medicaid	$14,027.30
Rate for Payer: Banner UC Health Medicaid	$14,027.30
Rate for Payer: Mercy Care Medicaid	$14,027.30

Female Reproductive System Reconstructive Procedures

Facility

IP

$14,027.30

Service Code	APR-DRG 5143
Hospital Charge Code	APRDRG5141
Min. Negotiated Rate	$14,027.30
Max. Negotiated Rate	$14,027.30
Rate for Payer: AHCCCS Medicaid	$14,027.30
Rate for Payer: Allwell Medicaid	$14,027.30
Rate for Payer: AZCH Complete Medicaid	$14,027.30
Rate for Payer: Banner UC Health Medicaid	$14,027.30
Rate for Payer: Mercy Care Medicaid	$14,027.30

Female Reproductive System Reconstructive Procedures

Facility

IP

$14,027.30

Service Code	APR-DRG 5143
Hospital Charge Code	APRDRG5142
Min. Negotiated Rate	$14,027.30
Max. Negotiated Rate	$14,027.30
Rate for Payer: AHCCCS Medicaid	$14,027.30
Rate for Payer: Allwell Medicaid	$14,027.30
Rate for Payer: AZCH Complete Medicaid	$14,027.30
Rate for Payer: Banner UC Health Medicaid	$14,027.30
Rate for Payer: Mercy Care Medicaid	$14,027.30

Female Reproductive System Reconstructive Procedures

Facility

IP

$25,511.32

Service Code	APR-DRG 5144
Hospital Charge Code	APRDRG5141
Min. Negotiated Rate	$25,511.32
Max. Negotiated Rate	$25,511.32
Rate for Payer: AHCCCS Medicaid	$25,511.32
Rate for Payer: Allwell Medicaid	$25,511.32
Rate for Payer: AZCH Complete Medicaid	$25,511.32
Rate for Payer: Banner UC Health Medicaid	$25,511.32
Rate for Payer: Mercy Care Medicaid	$25,511.32

Female Reproductive System Reconstructive Procedures

Facility

IP

$25,511.32

Service Code	APR-DRG 5144
Hospital Charge Code	APRDRG5144
Min. Negotiated Rate	$25,511.32
Max. Negotiated Rate	$25,511.32
Rate for Payer: AHCCCS Medicaid	$25,511.32
Rate for Payer: Allwell Medicaid	$25,511.32
Rate for Payer: AZCH Complete Medicaid	$25,511.32
Rate for Payer: Banner UC Health Medicaid	$25,511.32
Rate for Payer: Mercy Care Medicaid	$25,511.32

Female Reproductive System Reconstructive Procedures

Facility

IP

$5,050.08

Service Code	APR-DRG 5141
Hospital Charge Code	APRDRG5141
Min. Negotiated Rate	$5,050.08
Max. Negotiated Rate	$5,050.08
Rate for Payer: AHCCCS Medicaid	$5,050.08
Rate for Payer: Allwell Medicaid	$5,050.08
Rate for Payer: AZCH Complete Medicaid	$5,050.08
Rate for Payer: Banner UC Health Medicaid	$5,050.08
Rate for Payer: Mercy Care Medicaid	$5,050.08

Female Reproductive System Reconstructive Procedures

Facility

IP

$7,769.41

Service Code	APR-DRG 5142
Hospital Charge Code	APRDRG5143
Min. Negotiated Rate	$7,769.41
Max. Negotiated Rate	$7,769.41
Rate for Payer: AHCCCS Medicaid	$7,769.41
Rate for Payer: Allwell Medicaid	$7,769.41
Rate for Payer: AZCH Complete Medicaid	$7,769.41
Rate for Payer: Banner UC Health Medicaid	$7,769.41
Rate for Payer: Mercy Care Medicaid	$7,769.41

fentaNYL 100 mcg/2 mL Inj Sol [CQCH]

Facility

IP

$0.62

Service Code	HCPCS J3010
Hospital Charge Code	105922514
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.56
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Cash Price	$0.50
Rate for Payer: Self Pay Self Pay	$0.50

fentaNYL 100 mcg/2 mL Inj Sol [CQCH]

Facility

OP

$0.62

Service Code	HCPCS J3010
Hospital Charge Code	105922514
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.74
Rate for Payer: Aetna of AZ Commercial	$0.56
Rate for Payer: Aetna of AZ Medicare	$0.17
Rate for Payer: AHCCCS Medicaid	$1.74
Rate for Payer: Allwell Medicaid	$1.74
Rate for Payer: Allwell Medicare	$0.09
Rate for Payer: Amerigroup Medicare	$0.09
Rate for Payer: APIPA Medicare/Medicaid	$0.23
Rate for Payer: AZCH Complete Medicaid	$1.74
Rate for Payer: AZCH Complete Medicare	$0.09
Rate for Payer: Banner UC Health Medicaid	$1.74
Rate for Payer: Banner UC Health Medicare	$0.09
Rate for Payer: Bisbee Police All Plans	$0.16
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$0.42
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of AZ Commercial	$0.40
Rate for Payer: Copperpoint Commercial	$0.15
Rate for Payer: Health Net of AZ Commercial	$0.37
Rate for Payer: Health Net of AZ Medicare	$0.17
Rate for Payer: Humana of AZ Medicare	$0.09
Rate for Payer: Mercy Care Medicaid	$1.74
Rate for Payer: Self Pay Self Pay	$0.50
Rate for Payer: TriWest Medicare	$0.09
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.36
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.11

fentaNYL 12 mcg/hr TD Patch [CQCH]

Facility

IP

$12.11

Service Code	NDC 378911998
Hospital Charge Code	105922174
Hospital Revenue Code	251
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$10.90
Rate for Payer: Aetna of AZ Commercial	$10.90
Rate for Payer: Bisbee Police All Plans	$3.15
Rate for Payer: Cash Price	$9.69
Rate for Payer: Self Pay Self Pay	$9.69

fentaNYL 12 mcg/hr TD Patch [CQCH]

Facility

OP

$12.11

Service Code	NDC 378911998
Hospital Charge Code	105922174
Hospital Revenue Code	251
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$10.90
Rate for Payer: Aetna of AZ Commercial	$10.90
Rate for Payer: Aetna of AZ Medicare	$3.39
Rate for Payer: Allwell Medicare	$1.82
Rate for Payer: Amerigroup Medicare	$1.82
Rate for Payer: APIPA Medicare/Medicaid	$4.52
Rate for Payer: AZCH Complete Medicare	$1.82
Rate for Payer: Banner UC Health Medicare	$1.82
Rate for Payer: Bisbee Police All Plans	$3.15
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.23
Rate for Payer: Cash Price	$9.69
Rate for Payer: Cigna of AZ Commercial	$7.87
Rate for Payer: Copperpoint Commercial	$3.00
Rate for Payer: Health Net of AZ Commercial	$7.27
Rate for Payer: Health Net of AZ Medicare	$3.39
Rate for Payer: Humana of AZ Medicare	$1.82
Rate for Payer: Self Pay Self Pay	$9.69
Rate for Payer: TriWest Medicare	$1.82
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.06
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.18

fentaNYL 25 mcg/hr TD Patch [CQCH]

Facility

OP

$1.65

Service Code	NDC 47781042447
Hospital Charge Code	105922300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.48
Rate for Payer: Aetna of AZ Commercial	$1.48
Rate for Payer: Aetna of AZ Medicare	$0.46
Rate for Payer: Allwell Medicare	$0.25
Rate for Payer: Amerigroup Medicare	$0.25
Rate for Payer: APIPA Medicare/Medicaid	$0.62
Rate for Payer: AZCH Complete Medicare	$0.25
Rate for Payer: Banner UC Health Medicare	$0.25
Rate for Payer: Bisbee Police All Plans	$0.43
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1.12
Rate for Payer: Cash Price	$1.32
Rate for Payer: Cigna of AZ Commercial	$1.07
Rate for Payer: Copperpoint Commercial	$0.41
Rate for Payer: Health Net of AZ Commercial	$0.99
Rate for Payer: Health Net of AZ Medicare	$0.46
Rate for Payer: Humana of AZ Medicare	$0.25
Rate for Payer: Self Pay Self Pay	$1.32
Rate for Payer: TriWest Medicare	$0.25
Rate for Payer: UnitedHealth Group of AZ Commercial	$0.96
Rate for Payer: UnitedHealth Group of AZ Medicare	$0.30

fentaNYL 25 mcg/hr TD Patch [CQCH]

Facility

IP

$1.65

Service Code	NDC 47781042447
Hospital Charge Code	105922300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$1.48
Rate for Payer: Aetna of AZ Commercial	$1.48
Rate for Payer: Bisbee Police All Plans	$0.43
Rate for Payer: Cash Price	$1.32
Rate for Payer: Self Pay Self Pay	$1.32

fentaNYL 50 mcg/hr TD patch [CQCH]

Facility

OP

$12.58

Service Code	NDC 378912298
Hospital Charge Code	105922453
Hospital Revenue Code	251
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$11.32
Rate for Payer: Aetna of AZ Commercial	$11.32
Rate for Payer: Aetna of AZ Medicare	$3.52
Rate for Payer: Allwell Medicare	$1.89
Rate for Payer: Amerigroup Medicare	$1.89
Rate for Payer: APIPA Medicare/Medicaid	$4.70
Rate for Payer: AZCH Complete Medicare	$1.89
Rate for Payer: Banner UC Health Medicare	$1.89
Rate for Payer: Bisbee Police All Plans	$3.27
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$8.55
Rate for Payer: Cash Price	$10.07
Rate for Payer: Cigna of AZ Commercial	$8.18
Rate for Payer: Copperpoint Commercial	$3.11
Rate for Payer: Health Net of AZ Commercial	$7.55
Rate for Payer: Health Net of AZ Medicare	$3.52
Rate for Payer: Humana of AZ Medicare	$1.89
Rate for Payer: Self Pay Self Pay	$10.06
Rate for Payer: TriWest Medicare	$1.89
Rate for Payer: UnitedHealth Group of AZ Commercial	$7.33
Rate for Payer: UnitedHealth Group of AZ Medicare	$2.26

fentaNYL 50 mcg/hr TD patch [CQCH]

Facility

IP

$12.58

Service Code	NDC 378912298
Hospital Charge Code	105922453
Hospital Revenue Code	251
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$11.32
Rate for Payer: Aetna of AZ Commercial	$11.32
Rate for Payer: Bisbee Police All Plans	$3.27
Rate for Payer: Cash Price	$10.07
Rate for Payer: Self Pay Self Pay	$10.06

FERNOTRAC TRACTION SPLINT ADULT

Facility

OP

$1,546.00

Hospital Charge Code	24335304
Hospital Revenue Code	270
Min. Negotiated Rate	$231.90
Max. Negotiated Rate	$1,391.40
Rate for Payer: Aetna of AZ Commercial	$1,391.40
Rate for Payer: Aetna of AZ Medicare	$432.88
Rate for Payer: Allwell Medicare	$231.90
Rate for Payer: Amerigroup Medicare	$231.90
Rate for Payer: APIPA Medicare/Medicaid	$577.43
Rate for Payer: AZCH Complete Medicare	$231.90
Rate for Payer: Banner UC Health Medicare	$231.90
Rate for Payer: Bisbee Police All Plans	$401.96
Rate for Payer: Blue Cross Blue Shield of Arizona All Commercial	$1,051.28
Rate for Payer: Cash Price	$1,236.80
Rate for Payer: Cigna of AZ Commercial	$1,082.20
Rate for Payer: Copperpoint Commercial	$382.64
Rate for Payer: Health Net of AZ Commercial	$927.60
Rate for Payer: Health Net of AZ Medicare	$432.88
Rate for Payer: Humana of AZ Medicare	$231.90
Rate for Payer: Self Pay Self Pay	$1,236.80
Rate for Payer: TriWest Medicare	$231.90
Rate for Payer: UnitedHealth Group of AZ Commercial	$901.32
Rate for Payer: UnitedHealth Group of AZ Medicare	$278.28

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